免结扎技术在宫颈癌手术中的研究进展

宫颈癌是我国女性生殖道恶性肿瘤中发病率居第一位的肿瘤,该病的治疗方法仍是以手术治疗为主。手术治疗质量的评价模式的转变,很大程度上得益于许多新技术的使用和手术器械的发展和应用,特别是超声刀和Ligasure血管结扎系统等免结扎技术的应用。现就超声刀和Ligasure血管结扎系统等免结扎技术在宫颈癌手术中的应用进行综述。     

Pancreaticoduodenectomy in portal hypertension: use of the Ligasure

Background Purpose. The Ligasure Vessel Sealing System (LVSS) is a new bipolar device, put on the market in 1999, which provides safe and quick hemostasis, sealing blood vessels up to 7mm in diameter or tissue bundles without dissection or isolation. We tested this instrument in a patient with portal hypertension who had to be submitted to a complex abdominal procedure. Methods. A male patient (aged 57 years) with well-compensated cirrhosis of the liver, related to hepatitis C virus (HCV) (Child A) was diagnosed with a neoplasm of the pancreatic head. We performed a Whipple pancreaticoduodenectomy and hemostasis was almost entirely performed with the LVSS. All the blood vessels up to 7mm in diameter were sealed in this way. Larger vessels were suture ligated primarily. Results. No post-application bleeding was seen. No postoperative hemorragic complications occurred. A significant reduction in blood loss and in surgical time was noted. Conclusions. We believe that the LVSS could be extremely useful in all the fields of hepatopancreatobiliary surgery, especially in patients with portal hypertension with large intestinal and omental varices. The LVSS guarantees excellent hemostasis, reducing the risk of serious blood loss and shortening the time of surgery, so improving the prognosis.Via Cimarosa 2/a, 80127 — Naples, Italy Accepted at the fifth world congress of the International Hepato-Pancreato-Biliary Association — IHPBA     

Ligasure versus Ultracision® in thyroid surgery: a prospective randomized study

PURPOSE: New hemostatic technologies (NT) are often employed in thyroid surgery in the effort to reduce operating time and complications. The aim of this study is to compare three different hemostatic techniques. METHODS: This is a prospective randomized study. There were 150 patients, aged 56 +/- 14 years, randomized for total thyroidectomy with conventional technique (CT), Ligasure vessel sealing system (LI) or Harmonic Scalpel (HS) at the university surgical department. One hundred thirty-five patients had benign diseases; 15 had malignancies. RESULTS: Mean postoperative hospital stay was 2.6 days. Mean operation time was 113 +/- 31 min; in HS patients, it was significantly shorter (p < 0.001). Morbidity was 43.3%; mortality was nil. Morbidity was significantly different between CT and NT groups (p = 0.0002); HS and LI groups had a higher morbidity (p = 0.0001 and p = 0.02, respectively). Mean postoperative calcemia was 1.12 +/- 0.1 mmol/l with a significant difference between groups; NT patients had a significantly lower calcemia (p < 0.05). There was no difference in recurrent laryngeal nerve palsies and in intraoperative blood losses (p = ns). CONCLUSIONS: According to our experience, the only real advantage of new hemostatic technologies was a shorter operation time with HS.     

腹腔镜全子宫切除术中结扎束血管闭合系统的应用研究

目的评估结扎束血管闭合系统(LF1537 Blunt Tip)在腹腔镜全子宫切除术中应用的临床疗效,探讨其临床价值。 方法选取解放军总医院2014年1月至2016年1月期间收治并行腹腔镜全子宫切除术患者,根据术中是否使用结扎束血管闭合系统分为观察组(使用结扎束血管闭合系统)和对照组(常规手术),记录并比较两组的一般资料和手术相关指标。 结果两组的年龄、体质量指数、腹部手术史符合正态分布且差异无统计学意义(P＝0.625、0.287、0.664);两组的疾病构成差异无统计学意义(P＝0.808)。观察组的手术时间[(46.6 ± 19.1)min vs (65.8 ± 29.2)min]和术中出血量[(51.0 ± 21.9)ml vs (118.4 ± 50.7)ml]均少于对照组,差异有统计学意义(P< 0.001);两组的输血(2例 vs 6例)、住院时间[(6.3 ± 2.2)d vs (6.7 ± 2.8) d]、中转开腹(0例 vs 2例)、并发症发生(4例 vs 7例)比较,差异无统计学意义(P＝0.204、0.391、0.182、0.472)。 结论本研究中将结扎束血管闭合系统(LF1537 Blunt Tip)应用于腹腔镜全子宫切除术,能够更加安全有效的对血管和组织进行闭合和切割,缩短了手术时间,减少了出血量,使手术更加可靠、快捷,具有重要临床应用价值。     

安置心脏起搏器患者行乳腺癌手术的安全性分析

目的:探讨安置心脏起搏器患者行乳腺癌手术围手术期的安全性。方法:回顾性分析2013年1月至2017年12月复旦大学附属中山医院普通外科收治的13例安置心脏起搏器患者行乳腺癌手术的临床资料,以同期52例无心脏疾病、应用单极电凝的乳腺癌患者作为对照,分析并探讨安置心脏起搏器患者围手术期的安全性。结果:起搏器组13例患者术中生命体征均平稳,未出现起搏器工作异常状态,未出现新的心律失常,术后顺利康复。起搏器组与对照组的住院时间及术后引流情况无显著性差异。结论:对安置心脏起搏器的乳腺癌患者做好围手术期管理,术前对起搏器的型号和功能进行详细的了解,制定个体化的手术方案,术中密切监护,手术操作时尽量使用解剖刀锐性分离,使用双极电凝、Ligasure止血,避免使用单极高频电刀,手术的安全性是可以保证的。     

局部麻醉下Milligan-Morgan和Ligasure混合痔手术的对比分析

目的：探讨局部麻醉下外剥内扎术（Milligan‐Morgan）和血管闭合系统（Ligasure）两种不同混合痔切除术的临床疗效。方法选择2009年4月至2012年4月首都医科大学附属北京世纪坛医院普通外科行混合痔切除手术住院患者68例,分为Ligasure手术治疗34例（观察组）和Milligan‐Morgan治疗34例（对照组）,手术均采用局部浸润麻醉,术后随访6～36个月,比较两种手术方式的手术时间,术中出血量,总住院费用,术后住院时间、疼痛程度及并发症情况。结果对照组、观察组平均手术时间分别为（32．35±10．24）、（20．29±7．88）min,平均术中出血量分别为（29．71±14．67）、（4．97±2．89）mL,平均术后疼痛（最剧烈）分数分别为（5．88±1．12）、（3．47±0．83）分,平均术后住院时间分别为（7．97±2．55）、（2．29±1．17）d,平均住院费用分别为（1541．32±205．91）、（2872．32±652．30）元,两组比较均差异有统计学意义（P＜0．01）。住院期间及随访中,除对照组肛门渗液率和术后疼痛评分较观察组高外（P＜0．01）;两组其他并发症发生率比较,均差异无统计学意义（P＞0．05）。结论Ligasure术中出血量少,手术时间及术后住院时间短。     

结扎速血管闭合系统在痔切除术中的应用

为探讨结扎速血管闭合系统（Ligasure）在痔切除术中的使用方法,并与传统手术（Milligan—Morgan术）对比进行疗效分析。将58例Ⅲ、Ⅳ期混合痔患者随机分成两组,观察组29例患者在骶麻下用Ligasure实施痔切除术,对照组29例采用传统手术（MilliganMorgan术）,观察两组手术时间、术后恢复时间、术后疼痛和并发症情况。结果显示,两组手术时间、术后恢复时间、术后使用止痛药次数、肛门狭窄及肛门失禁例数均有显著性差异（P〈0．05）。结果表明,Ligasure用于痔切除术具有疗效可靠,手术时间短,患者术后疼痛轻,并发症少等优点。     

Haemorrhoidectomy with Ligasure™vs conventional excisional techniques: meta‐analysis of randomized controlled trials

Objective To compare the use of LigaSure devices with conventional excisional techniques, circular stapling and use of Harmonic Scalpel in patients with symptomatic haemorrhoids and to review literature on LigaSure technology (Valleylab Inc. USA). Method A literature review was performed using the National Library of Medicine’s Pubmed Database using the keywords Ligasure, haemorrhoidectomy, vessel sealing technology. Randomized trials comparing LigaSure with other techniques of excisional haemorrhoidectomy with valid end points were reviewed in the present article and included in a quantitative meta‐analysis. Results There was no significant difference in the proportion of patients cured after Ligasure haemorrhoidectomy or other excisional techniques (P > 0.05). Patients treated with LigaSure had a significantly shorter operative time (P < 0.001), postoperative pain VAS Score (P < 0.001), wound healing time and time‐off from work (P < 0.001), than the patients submitted to excisional techniques. Postoperative bleeding did not significantly differ between the two groups (P = 0.056); however, the surgeons observed a reduction of intra‐ and postoperative bleeding using LigaSure?. In comparison to the circular stapler and Harmonic Scalpel the authors found similar postoperative outcomes and a slightly favourable trend for LigaSure regarding postoperative complications, ease of handling and length of the procedure. Conclusion Our meta‐analysis shows that Ligasure haemorrhoidectomy is a fast procedure characterized by limited postoperative pain, short hospitalization, fast wound healing and convalescence.     

Ligasure在非脱垂子宫经阴道切除术中的应用

目的探讨Ligasure（血管速扎闭合系统）在阴式子宫切除术中的应用的价值。方法从2007年11月至2009年11月,我院对78例非脱垂子宫患者采用Ligasure阴式子宫切除术作为观察组,随机选择同期以传统缝合术进行阴式子宫全切术78例作为对照组。比较2组手术时间、术中出血量及术后恢复情况。结果手术时间,观察组为（38±22）min,对照组为（68±35min）,P〈0.01;术中出血量,观察组为（93±85）mL,对照组为（152±108）mL,P〈0.01;平均术后住院时间,观察组为5.2d,对照组为5.5d,P〉0.05;术后3个月阴道残端情况,观察组愈合良好,对照组5例发现阴道残端,可见线头或肉芽。结论采用Ligasure的改良非脱垂子宫经阴道切除术具有手术时间短、术中出血量少、术后并发症少、操作简单、安全可靠、病人恢复快及易被患者接受,值得临床推广。